Coming up in March and April, I’ve got two, two-day professional workshops scheduled at the University of Montana. Together, these workshops can earn you 2-credits through the U of M . . . or you can enroll for continuing education credit (one workshop = 2 days = 13 CE hours). Whatever you decide, coming to Missoula in early March and early April is pretty fabulous. We’ve scheduled these workshops for the first Friday and Saturday in Missoula to coincide with the First Friday Art Walk. That way you can workshop during the day and walk around downtown Missoula and check out fantastic Montana art Friday evening.

The workshops and their descriptions are below:

March 2 and 3, 8:30am to 4:30pm: Working with Challenging Youth and Parents . . . and Loving It

Counseling difficult youth and challenging parents can be immensely frustrating or splendidly gratifying. The truth of this statement is so obvious that the supportive reference, at least according to many teenagers is, “Duh!” Using storytelling, video clips, live demonstrations, group discussion, and skill-building break-out sessions, John will present essential evidence-based principles and over 20 specific techniques for influencing “tough” clients or students. Techniques for working with youth will include, but are not limited to: (a) the affect bridge, (b) what’s good about you?, (c) empowered storytelling, (d) generating behavioral alternatives, (e) the three-step emotional change technique, and many more. Dr. Sara Polanchek will join John for the parenting portion of the workshop. They will describe essential principles for working effectively with parents, how to conduct brief parenting consultations using a positive, solution-focused model, and strategies for providing parents with specific suggestions and advice to parents. Issues related to ethics and culture will be highlighted and discussed throughout this two-day workshop.

If you want to call for more information: Call 406-243-5252 and leave a message if our administrative person is away. Or you can always email me: john.sf@mso.umt.edu

April 6 and 7, 8:30am to 4:30pm: Variations on the Clinical Interview: Collaborative Approaches to Mental Status Examinations, Suicide Assessment, and Suicide Interventions

The clinical interview is the headwaters from which all mental health assessment and interventions flow. In this workshop, following an overview of clinical interviewing principles and practice, skills training for conducting the mental status examination (MSE) and suicide assessment interviews will be provided. Participants will learn MSE terminology, common symptom clusters and presentations, and strategies through which the MSE can be more collaborative and user-friendly. Additionally, participants will learn a flexible model for conducting suicide assessments. This model features eight core suicide dimensions and techniques for directly and collaboratively questioning clients about suicide ideations, previous attempts, hopelessness, and more. Five suicide interventions will be featured: alternatives to suicide; separating suicide intent from the self; interpersonal re-connection; neodissociation; and safety-planning.

This morning I’m in Orange County, CA on my way to Chicago from Missoula and, naturally, feeling a little emotionally dysregulated. I never used to like the term emotional dysregulation much, but now I think it’s pretty good. Among other things, relational disruptions, travel, and trauma can all produce a mix of emotions that might be aptly described as emotional dysregulation. Recently, I’ve had an experience where I find my response is relatively equal and shifting parts of excitement and anxiety. It’s not a terrible experience; I know there’s positive excitement in there somewhere. But sometimes it gets overshadowed by the anxiety.

Back to Orange County. The link below takes all the CASP participants (and other interested parties) to the “long form” of the presentation for today, which is quite surprisingly titled, “Tough Kids, Cool Counseling.”

October is almost always a big month for counseling and psychology conferences and workshops. This October is no exception. I’m posting my October workshop presentation schedule here, just in case you want to say hello and possible collect some continuing education credit.

Last week I had the honor and privilege to spend a day with a group of about 340 mostly school psychologists in Columbus, Ohio. Talk about amazing. Were they nicer than last month’s group in Rock Hill, South Carolina? I don’t know. Both groups were awesome. I’ll keep the details secret just so everyone will wonder why gatherings in Rock Hill and Columbus are or will be inevitably fantastic.

The excerpt follows . . . and it’s followed by a link to an “Extra SCASP Handout” with more detailed info about the SCASP and Columbus Workshop techniques.

Passing Personal Notes

A simple method for re-engaging an angry or “checked out” child/adolescent in counseling is the note-passing technique (J. Sommers-Flanagan & Sommers-Flanagan, 1995). This technique is used when a young client suddenly appears sullen, angry, or quiet and nonresponsive. In some cases, counselors may have clues as to why the client has become quiet. However, in other cases the young client’s silence may be a complete mystery. Whatever the case, note passing is used to communicate to clients through an alternative format, to reduce pressure on young clients to be verbally productive, to express empathy for an emotional state, and to surprise the client (and thereby modify affect) by being supportive and affectionate rather than critical in response to the client’s silence. When counselors have a positive response to client silence it can be conceptualized as a corrective emotional experience (Alexander & French, 1946).

Children, teenagers, and even some college students are notorious for passing notes in class. Most often the notes are brief and focus on gossip or on whatever is bothering the note writer at the moment. Generally speaking, among teenagers, passing notes is cool.

To utilize this technique all you need is a notebook and pencil or pen. When your client is quiet and perhaps angry or sullen and efforts to interact verbally result in continued withdrawal and silence, simply pick up the notebook and begin writing. This activity may attract the youth’s attention. Your client may assume you’re writing something negative about them. One 12-year-old boy immediately questioned: “Are you writing a note to the group home?” as he expected he would be reprimanded for becoming silent in therapy. I (John) responded: “Nope, I’m just writing a note to you.”

When using this technique, hold the notebook so your client cannot see the content of your note; part of the effect of this technique rests on your client’s surprise at receiving a personal note and on surprise at the content of the note. Of course, the note should be individualized and personal (see Box 4.1 for a sample note).

Box 4.1

Note-Passing Sample

Hey Tonya:

What’s up? Seems like you might be kind of upset today, but I might be wrong. I hope I didn’t do something to bug you or make you mad. If I did, be sure to let me know when you feel like it, okay? I know that counseling can be kind of dumb or seem like a waste of time or even make people mad sometimes. I hope we can find ways to make this be a good thing for you. Thanks for coming—even when you might not feel like it. So, how are you feeling, anyway? Do you think it is a little too warm in this office? That’s a cool sweater you’re wearing.

Your Very Own Counselor,

Rita S-F

P.S. Write back if you want to.

[End of Box 4.1]

We recommend writing the personal note with a person-centered flavor (Rogers, 1961). Additionally, it’s useful to include a humorous or light closing and an interest in hearing back from your client. Finally, write only what your clients will feel comfortable taking home (e.g., critical comments about teachers or family members, even if such comments are in the service of empathy and emotional validation, may have negative repercussions).

Most of our young clients respond positively to this procedure. Often they act surprised when told: “I wrote you a note.” One client asked to take it into the bathroom to read. Other clients have asked: “Can I keep it?” Our response to these requests is usually something like, “Of course. I wrote it to you.” Another client refused the note during the session, but accepted it later from her mother (i.e., it was sealed and given to the mother to deliver at home). Sometimes young clients have initiated a note-writing exchange after receiving a note from one of us. On the other hand, we’ve had some young clients rip the note to shreds or toss it in the trash which is perfectly acceptable from our perspective because we view these more aggressive responses as a non-violent and perhaps useful anger expression.

Personal notes can reopen communication, possibly because the activity moves young people out of a negative mood state; it’s hard for clients to maintain a negative mood state when they’re also experiencing surprise or pleasure (Mosak, 1985). Research suggests that it’s common for young people who behave aggressively to anticipate hostility or overt coercion from others during times of stress or threat (Dodge, Lochman, Harnish, Bates, & Pettit, 1997; Dodge & Somberg, 1987). This anticipatory tendency has been labeled the misattribution of hostility. For youth who anticipate hostility, a nonjudgmental, funny, or caring note can be quite a surprise. Also, many young people we see in therapy have never received a personal handwritten note from an adult (especially from an adult male). Overall, a sincere and nonthreatening effort by a counselor to enhance emotional intimacy and establish a personal connection usually does not go unnoticed.

Young clients or students and their parents will sometimes be immediately resistant to your efforts to help them change. I don’t mean this in the old-fashioned psychoanalytic form of resistance that blames clients. I mean this as a natural resistance to change. I think we’ve all felt it. Someone has some helpful advice and we feel immediately disinclined to listen and even less inclined to follow the advice. I remember this happening with my father—even when he wanted to tell me something about sports. Of course, he knew a TON more about sports than I did, but logic was not the issue. When it comes to relationships and influencing people, logic is rarely relevant.

If we can buy into using the word resistance—despite the fact that Steve de Shazer buried it in his backyard and had a funeral for it, we would be likely to conclude that resistance behaviors are especially prominent among youth who view their presence in therapy as involuntary. Think of school, court, or parent referred children. Below, in an effort to capture what happens in these situations, Rita and I came up with what we call common resistance styles. Again, the point is not to blame clients or students; after all, they usually come into counseling or therapy with a history that makes their resistance totally natural. Besides, why should we expect them to pop into a therapist’s office and suddenly experience trust and share their deepest feelings.
In combination with these so-called resistance styles, we’ve also developed a range of possible therapeutic responses. To be with de Shazer’s (1985) solution-focused model and because they constitute a first best guess regarding how to respond to these particular resistance styles, we refer to these responses as “formula responses.” Keep in mind that if one formula response is ineffective, an alternative one may be used to reduce and manage this pesky resistance-like behavior.

Resistance Style: Externalizer/Blamer
This young person quickly blames everyone and everything for his or her problems. S/he may feel persecuted; there also may be evidence supporting his/her persecutory thoughts and feelings. Alternatively, the youth may simply have trouble accepting personal responsibility.

SAMPLE STATEMENT: “I would never have flunked science if it weren’t for my teacher. He sucks big-time.”

Formula Responses: One key to responding to this youth is to blatantly side with his or her affect. In the early stages, confrontation with this type of youth is generally ill-advised. For example, Bernstein (1996) states: “Despite a lack of evidence to back up their arguments, we listen carefully without passing judgment” (p. 45). The blamer is sometimes so hypersensitive to criticism that he sees it coming a mile away. Therefore, especially at the outset of therapy, therapists should be cautious about providing criticism or negative feedback. As the client blames others be sure to grunt and moan and say things like, “Oh yeah, I hate it when teachers aren’t fair.” or just use standard person-centered reflections, “You’re saying that being around your teacher really sucks . . .it feels real bad.”

Resistance Style: The Silent Youth
This youth may refuse to speak or may boldly claim that she doesn’t have to talk to you. This youth may have strong needs for power and control and/or may be afraid of what she might say during counseling.

SAMPLE STATEMENT: “I don’t have to talk to you. And you can’t make me.”

Formula Responses: For the completely silent youth who appears to be stonewalling, it may be useful to use a combination of youth-centered reflection of feeling/content and self-disclosure or forced teaming. For example, you might say: “Seems like you really don’t want to be here and you also really don’t want me to know anything about you.” And/or: “If I were you, I wouldn’t trust me either. After all, you were sent here by people you don’t trust and so you probably think I’m on their side. I’d like to prove I’m not on their side, but the only way we can really shock your parents (or probation officer) is by you talking with me and then you and I teaming up to help you have more control over your life.” In the case where the client boldly claims that she does not have to talk with you, it can be helpful to strongly agree with the youth’s assertion (and then simply inquire as to what has been happening in the youth’s life.: “You are absolutely right. You ARE totally in control over whether you talk with me and how much you talk with me.” Then, after a short pause say, “Now, what do you want to talk about?” Sometimes acknowledging the youth’s power and control can decrease his/her need for it.

Resistance Style: The Denier
This is the youth who Repeatedly says: “I’m fine” or “I don’t know” when neither statement is likely to be the truth. These youths can be especially frustrating to therapists because whatever life circumstances that led the youth to therapy are clearly difficult and progress might be made if the youth would admit to having problems. Unfortunately, these youths may have such fragile self-esteem that admitting that any problems are occurring in their lives is very threatening.

SAMPLE STATEMENT: “I’m fine, I don’t have any problems.”

Formula Responses: With youth who say, “I’m fine” we suggest one of two possible formula responses. First, you might say: “If you’re fine, then somebody in your life must not be fine, otherwise, you wouldn’t be here. So, tell me about who forced you to come and what his or her problems are?” The purpose of this statement is to get youths to at least become “blamers” so that you can side with the affect and start building rapport. Second, Bernstein (1996) suggests a statement similar to the following: “You may be right and you may be fine, but if you don’t talk with me about your life, I’ll never know whether you’re fine or not.” Suggested formula responses to “I don’t know” include: “Okay, then tell me something you do know about this problem” or “Tell me what you might say if you did know” or “Boy, it sounds like there are lots of things about your life that you don’t know anything about. We’d better get to work on figuring this stuff out” or John’s favorite, which is: “Take a guess.”

Resistance Style: The Nonverbal Provocateur
Some young clients are so good at irritating other people with their nonverbal behavior that they deserve an award. These youth are often keeping adults at a distance because they don’t trust that the adults will understand or appreciate their adolescent dilemmas. These youths also are notorious for being able to “piss off” their parents, teachers, probation officers, and therapists. They may do so through eye-rolls, sneers, lack of eye contact, or other irritating nonverbal behaviors. Analytic theorists believe this is because they have such profound self- hatred that they unconsciously believe they deserve to be treated poorly by others, especially adults (Willock, 1986, 1987).

Formula Responses: When faced with the nonverbal provocateur, we recommend using the strategy we have referred to elsewhere as “interpersonal interpretation” (See Tough Kids, Cool Counseling). This strategy includes several steps. First, the therapist allows the youth to make whatever disrespectful nonverbal behaviors she wants to, without acknowledgment. Second, after a substantial number of eye-rolls, etc., have occurred, the therapist makes a statement such as: “Are people treating you okay.” This statement is designed to provoke complaints from the youth about whomever has been treating her so poorly. Third, the therapist discloses his or her reactions to the nonverbal behaviors: “The reason I bring this up is because, for a moment, significant sigh).I felt like being mean to you.” Fourth, the therapist suggests that the youth may already realize why the therapist “felt like being mean” to the youth or discloses that these feeling arose in response to the youth’s nonverbal behaviors. Fifth, the therapist suggests that the reason other people are treating the youth poorly is related to eye-rolls, etc., outside of therapy. Sixth, the therapist inquires as to whether the youth has control over his/her irritating nonverbal behaviors. Seventh, the therapist encourages the youth to conduct an experiment to see how people treat him/her one day when using lots of eye-rolls and another day while not using eye-rolls.

Resistance Style: The Absent Youth
There are at least two types of absent youths. First, there are young people who arrive with their parent or parents, but who refuse to leave the waiting room. Second, there are young clients who, after an initial appointment, keep missing their subsequent appointments.
In either case, resistance is high. These youth may be even more afraid of therapy and losing power the control than other youth, who at least make it into the counseling office.

SAMPLE STATEMENT: “I’m not going back and you can’t make me.”

Formula Responses: It’s essential that young clients or students not be “dragged” into the therapy office. Therefore, the youth is simply informed that the session(s) will proceed without the youth present but that the session will still be “about” the youth. Subsequently, the session focuses on parent education and family dynamics. During this session, therapist should offer and serve food and drink to the participating family members. Also, partway through the session (if the young client is in the waiting room) one family member may ask once more if the youth would like to join them in the meeting. However, this request should only occur once and it should not involve any pleading. For young clients who miss their appointments, an invitation letter as suggested by White and Epston may be useful or, if you’re more behaviorally inclined, a contingency program may be designed to provide the youth with appropriate reinforcers and consequences.

Resistance Style: The Attacker
Similar to Matt Damon in the film Good Will Hunting, some youth will try to provoke the therapist by attacking whatever therapist personal traits that he or she can identify. It may be office decor, personal items (e.g., family pictures), clothing, the office itself, the voice tone, body posture, attractiveness, etc. The attacker’s ploy is often clear from the outset: The best defense (aka: resistance) is a good offense.

SAMPLE STATEMENT: “I noticed that everyone else here has a bigger office than you. You have a shitty little office; you must be a shitty little therapist.”

Formula Responses: We believe that two rules are crucial with young clients who consistently verbally attack the therapist. First, unlike Robin William’s character in the popular movie, you should not attempt to “choke” the youth (even therapist’s though you may feel like choking the client). In other words, therapists should not respond defensively or offensively to attacks by the youth. Second, the therapist may interpret the youth’s behavior by clearly demonstrating that the comments, whether true or not, say much more about the youth than they say about the therapist. After a few interpretations of the youth’s underlying psychodynamics, the youth usually will cease and desist with the attacks because he or she sees that every attack comes back to him or her in the form of an interpretation.

Resistance Style: The Apathetic Youth
The apathetic youth is similar to the denier, except that the formidable strategy of simply not caring about anyone or anything is the primary defense. This defense often arises out of depressive or substance related emotional and behavioral problems

Formula Responses: Hanna and Hunt (1999) recommended using a sub-personality or ego state approach to dealing with adolescent apathy. This approach involves three steps: (a) take great care to empathize with the youth’s apathy; this might involve saying things like, “Okay, okay, I get it, you really don’t give a shit.”; (b) after empathizing, use a question like, “I know you don’t care, but isn’t there a little part of you, maybe a voice in the back of your head or something, that worries, maybe only a tiny bit about what might happen to you?”; (c) focus on the part of the youth that acknowledges caring about what happens and eventually begin labeling the “caring” part of the adolescent as the “real” self, while reducing the apathetic part of the self to the “fake” self.